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Early parenteral nutrition is associated with improved growth in very low birth weight infants: a retrospective study
  1. René Liang Shen1,
  2. Christian Ritz2,
  3. Yanqi Li1,3,
  4. Per Torp Sangild1,4,5,
  5. Ping-Ping Jiang1
  1. 1 Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
  2. 2 National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
  3. 3 NBCD A/S, Søborg, Denmark
  4. 4 Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  5. 5 Department of Paediatrics, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
  1. Correspondence to Dr Ping-Ping Jiang, Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, 1870, Denmark; pipi{at}


Objective To assess the association between early initiation of parenteral nutrition (PN) and body growth in preterm infants with very low birth weight (VLBW).

Design Causal inference analysis with confounders preselected by causal diagram based on the NeoNutriNet cohort containing data of infants born between 2011 and 2014 from 13 hospitals from 5 continents.

Patients Neonates with birth weight ≤1500 g.

Interventions PN initiated within the first day of life (early PN) versus within day 2–5 (delayed PN).

Main outcome measures The primary outcome was body weight z-scores at postmenstrual age (PMA) 36 weeks or early discharge or death, whichever comes first (WT z-score END). Secondary outcomes included WT z-scores at week 1 and 4 of life (WT z-scores CA1 and CA4), corresponding growth velocities (GVs), mortality and incidence of necrotising enterocolitis (NEC), and duration and episodes of antibiotic treatment.

Results In total, 2151 infants were included in this study and 2008 infants were in the primary outcome analysis. Significant associations of early PN were found with WT z-score END (adjusted mean difference, 0.14 (95% CI 0.05 to 0.23)), CA4 (β, 0.09 (0.04 to 0.14)) and CA1 (0.04 (0.01 to 0.08)), and GV PMA 36 weeks (1.02 (0.46 to 1.58)) and CA4 (1.03 (0.56 to 1.49), all p<0.001), but not with GV CA1 (p>0.05). No significant associations with mortality, incidence of NEC or antibiotic use was found (all p>0.05).

Conclusions For VLBW infants, PN initiated within the first day of life is associated with improved in-hospital growth.

  • infant development
  • neonatology
  • epidemiology

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors The cohort was curated by YL. Analysis was performed by RLS and P-PJ. The manuscript was drafted by RLS and P-PJ and reviewed by RLS, CR, YL, PTS and P-PJ. P-PJ is the guarantor and responsible for the overall content. All coauthors approved the final manuscript.

  • Funding This work is supported by Innovation Fund Denmark via the NEOMUNE project. RLS was supported by the BRIDGE—Translational Excellence Programme ( of University of Copenhagen, funded by the Novo Nordisk Foundation (NNF18SA0034956).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.